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2013/2014 I Clerk to the Board, Minutes &Records Dept. Expires 3299 Tamiami Trail East, Suite#401 (Staff use onl ) Building F, 4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Patrick Vanasse Date9/18/2013 Business Address 6610 Willow Park Drive, Ste. 200 Naples, FL 34109 239.597.0575 pvanasse @consult-rwa.com . Business Telephone E-Mail NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). See attached list 2). (PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY / Z.. , __ __..._ Lobbyist Signature State of Florida County of Collier The foregoing registration was sworn to and subscribed before me on this 23 day of$ pkm bei Zo/3, by Pa,1/i c/c V4,1 arse , who is personally known to aeor has produced as identification and who did take an oath. i �z �, ANAai LANDO°. Ai NUTA Y'?ULILIC STATE OF i=LC5WL BY: ,/ Comm#EFl ,3, `' Deputy Clerk/Nota 'al The annual registration fee is $25.00 per Lobbyist, according to Collier County Ordinance No. 2003-53, as amended by Ordinance 2004-05, Ordinance 2007-24 and Ordinance 2013-39. Please make payment to: Collier County Clerk of Courts or Dwight E. Brock, Clerk of Courts and mail to the address listed at the top of the form. o 71 m m m m p p n n n n n n n 0 n c)c) n n n n n non W W W CO CO CO CO CO D D D D z 0 * N 0 0 a 0 n) CD 0 0 0 0 0 0 0 0 0 0 0 0 O = cD 0 C . 0 CD 0 CD 0 C c Cy •W c0 0 c. 7 .(1 7 3 3 Q 3• 3 = _ = 0 = _ _ = `< `< N 3 '0 r. 7'5- 0T. 7 cD T N l O O (D 3 D `/\ N a a (D 7 7. CD CD CD (� [D (� N, (D c�D (D c�D O O (D CD ? O N 3 0 0 0 w S 9 3' 3 X O m cD 7 3 W '. 5 D o m 0 �' >_ > -D m n g n n n n T 01 a r v 3 W ° ° (� °. S. 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Dwight E. Brock oz. �J\` Clerk of the Circuit Court F.r.}`riiii`4 0 gffq , c,- - , _ p\ c,,,_ @(--,--„ :)Q ,. Customer Deputy Clerk Clerk Office Location JONES, EMBLIDGE, BMR CASHIER Collier County Govt. Center VANASSEE, WRIGHT & MinutesandRecords @CollierClerk.co Building F, 4th Floor PAPPAS m 3299 Tamiami Trail East, Suite RWA, INC. 239-252-2646 401 6610 WILLOW PARK DR STE P.O. Box 413044 200 Naples, Florida 34101-3044 NAPLES, FL 34109-9014 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 5 BMR Lobbyist Registration $25.00 $125.00 TOTAL AMOUNT DUE $125.00 Check#24825 ($125.00) BALANCE DUE $0.00 Note: Disclaimer: All transactions are subject to review/verification.The Clerk reserves the right to correct for clerical errors and to assess or refund charges as needed. 1©O11DOQT@OQ @OB110 Page 1 of 1